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Sooner or later, everyone will grieve the loss of a close
relative or friend. Although grief is nearly universal, it
expresses itself in many different ways and at times resembles
major depression. Frequent crying spells, depressed mood, sleep
disturbances, and loss of appetite are common during the
bereavement process, for example. Even so, mental health
professionals have typically viewed the process of grieving as a
normal response to loss and not an illness to be treated.
In this issue of the Harvard
Mental Health Letter, we look closely at the
nature of grief. Does grief have stages, or is it less linear?
What can people do to help themselves? And how does someone know
when it's time to get help? We also offer advice for patients and
resources for more information.
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Losing a close friend or family member can be devastating. All the
small details of daily life — getting out of bed, making meals,
going to appointments, taking care of children, handling
responsibilities at work — may seem monumentally hard or
inconsequential. It is important for people to let the
nonessentials slide and focus on ways to get through this difficult
time.
Dr. Michael Hirsch, a psychiatrist at Massachusetts General
Hospital and medical editor of Harvard Medical School's Special
Health Report Coping with
Grief and Loss: A Guide to Healing, offers the following
advice. Although some tips may seem basic, they are vital for
enabling people who are grieving to work through the process.
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Grief can be so intense and long-lasting that it sometimes
resembles a psychiatric disorder. As many as 50% of widows and
widowers, for example, develop symptoms typical of major depression
in the first few months after a spouse dies. They may also have
hallucinatory experiences — imagining that the dead are still
alive, feeling their presence, hearing them call out.
These symptoms, upsetting as they may be, are usually normal
responses to a profound loss. In most people, the symptoms ease
over time. One review noted that 15% of people who are grieving are
depressed one year after a loss. By two years, the proportion falls
to 7%.
But if the symptoms are intense enough to interfere with
relationships, work, school, and other areas of life, the problem
may be complicated grief — a term that describes a grieving process
that is particularly difficult. Also known as protracted or chronic
grief, it combines features of depression and post-traumatic stress
disorder (PTSD) — which is why some professionals call it traumatic
grief. One study estimated that nearly 5% of all older adults were
experiencing complicated grief.
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